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76AG63-CESO6 I0-62 APPLICATION FOR ELECTRICAL PERMIT -�- -
COUNTY OF LOS ANGELES ��� /"
DEPARTMENT OF COUNTY ENGINEER .BUILDING
BUILDING AND SAFETY DIVISION ADDRESS L9 O
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE
LIGHT d
OUTLETS FIRST 20 $20 $ 4 QO OWNER
MAIL
ADD'L a ADDRESS
SWITCH. OVER 20 •10
TOTAL ^ CITY c-i, TEL. NO. -511 o
LIGHTING FIRST 20 .20 '-1
FIXTURES A"'L 10 ELECTRICIAN ,
OVER 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS` 4
GARB.DISPA . STA'COOK
CITY TEL. NO." --)-
DISHWASH. , AUTO.-WASH. STATE
LICENSE NO.
SPACE HTRS. STA.APP.(I/E X.P.MAX.) .50
MOTORS: "OVER NOT OVER H.P. DISTRICT NO. GROUP •ZONE PROCESSED BY
O 1 1.00 0O T. A'/
1 3 1.50 INSPECTION RECORD
3 S 2.00 }
d
8 15 2.50 O
V
15 50 3.00 .fir
50 100 5.00 O
SIGNS: NO.TRANS. d
NO.LAMPS h
z
SERVICE O-GOOV-NOT OVER 200A 1.00 '
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00 ,
MISC.
PERMIT.ISSUING FEE 2.00 '
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
LNQBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
LL COUNTY ORDINANCES AND STATE LAWS REGULATING
CAL WIRING. WIRINGEBY CERTIFY THAT-I AM PROPERLY REGISTERED AND/ORD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ED RESIDENTIAL P PERTY. POWER
UREUTILITY CO.NOTIFIED
MITTEE
FINAL -
LIDATION ARTHUR C. VEIT
CK MO • CASH• SUPERVISING ELECTRICAL ENGINEER.
LiCo 1 4 1 5, JUL 16
2 D . 1 8.9 O